What Is Your Diabetes IQ?

Drop that meter—it won’t help you with this kind of diabetes test. For this one, you’ll need to tap all the self-care know-how you’ve mastered, with help from the seven self-care behaviors developed by the American Diabetes Association (ADA) and the American Association of Diabetes Educators. These skills are designed to help you successfully manage your diabetes. Ready to test your diabetes IQ? Grab a pencil, and find out if you’re a self-care expert or if you’ve been harboring misconceptions about your diabetes lifestyle.

7 Self-Care Behaviors*:

Healthy Eating

Being Active

Monitoring

Taking Medication

Reducing Risks

Problem Solving

Healthy Coping

* These behaviors, defined by the American Association of Diabetes Educators and the American Diabetes Association, address the skills needed in diabetes self-management education.

1. Do you have to cut all sugar from your diet?

A Yes. Sugar worsens diabetes.B No. I can eat as much sugar as I want, as long as it’s natural. C No. I can still eat foods with sugar in moderation.

2. If your job requires you to be on your feet all day, do you still have to exercise?

A No. I get enough physical activity at my job.B Yes. I’ll still want to do at least 30 minutes of exercise five days a week.C No. I need no additional exercise as long as I get 10,000 steps a day.

3. If your doctor checks your A1C twice a year, do you have to do checks with your home meter?

A Yes. Blood glucose monitoring can help me adjust my lifestyle and/or insulin dose. B Yes. I still need to log my blood glucose readings to discuss with my doctor or diabetes educator. C No. The A1C checks are enough to make sure I’m doing well with my diabetes.

4. Can you skip your meds if you don’t see a change in your blood glucose with regular use?

A Yes. There’s no need to waste my time and money if they’re not helping.B No. I need to continue taking my medications and discuss my expectations and concerns with my doctor. C No. But I don’t have to take them all the time.

5. You’ve been feeling good lately. Can you skip routine doctor visits until you have a problem?

A No. I still need to go to my scheduled checkups, as these visits help screen for diabetes-related complications. B Yes. If I’m feeling fine, there’s no reason to have checkups.C Yes. I can skip them as long as my last A1C was within target range.

6. If you don’t understand results from your blood glucose checks, is it best to wait until your next scheduled appointment with a health care provider to get advice?

A Yes. In the meantime, I’ll search for answers online.B Yes. If I don’t know what the numbers mean, I shouldn’t make any lifestyle adjustments.C No. I can call my doctor or diabetes educator to talk about my readings.

7. Managing your diabetes on a daily basis has you on an emotional roller coaster. Is there any point in discussing your feelings?

A No. It’s difficult for anyone else to truly understand my diabetes.B No. I have a health care team to help manage the condition, but they can’t lend emotional support. C Yes. I have friends, family, caregivers, coworkers, a health care team, and people in the diabetes community who can be my support system.

Answers

1. Do you have to cut all sugar from your diet?C No. I can still eat foods with sugar in moderation.Self-Care Behavior: Healthy Eating

Completely avoiding sugar is “unrealistic, unpalatable, and unsustainable,” says David Nathan, MD, director of the Diabetes Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School.

You may not realize that many healthy foods contain sugar, says Kara Mitchell, MS, RD/LDN, ACSM, RCEP, CDE, wellness manager at the Duke Health & Fitness Center in Durham, North Carolina. For instance, dairy products such as yogurt contain lactose, which is a sugar. And fruit contains fructose. But these foods also supply other nutrients that are good for you. “The general approach is to have more balance in your diet and take a moderate approach to carbohydrates,” she says.

No food is totally off the table—with one exception. Nathan recommends eliminating sugary sodas altogether. “They hold no nutritional value and have a profound effect on blood glucose levels,” he says.

2. if your job requires you to be on your feet all day, do you still have to exercise?B Yes. I’ll still want to do at least 30 minutes of exercise five days a week.Self-Care Behavior:Being Active

Having an active job beats sitting at a desk for hours on end, which research suggests can raise your risk for heart disease and early death. The downside? Those extra steps don’t necessarily count toward your exercise goals. In addition to any steps you take throughout the day, aim for a minimum of 150 minutes of moderate-intensity activity a week. For walkers, this translates to a brisk 4 miles per hour, or a 15-minute-mile pace. Not sure of the intensity of your workout? Try the talk test: Moderate-intensity activity will allow you to talk with ease (but make it difficult to belt out a tune), while more-intense activity will require you to pause frequently during conversation.

3. If your doctor checks your A1c twice a year, do you have to do checks with your home meter?A & B Yes. Blood glucose monitoring can help me adjust my lifestyle and/or insulin dose. And I still need to log my blood glucose readings to discuss with my doctor or diabetes educator. Self-Care Behavior:Monitoring

Your doctor will check your A1C, but it only reveals your average blood glucose over time. What it won’t tell you is whether your blood glucose is frequently swinging from low to high during the day. That’s one reason why monitoring blood glucose is a must for people with type 1 diabetes, says Nathan. Plus, those readings allow you to properly dose mealtime insulin, adjust insulin and carb needs for exercise, manage sick-day needs, check for low blood glucose (hypoglycemia), and more.

For people with type 2, how often you check varies depending on whether you take glucose-lowering medication. You may need several checks a day or only a few checks a week. Regardless, monitoring blood glucose allows you to see if your numbers are in your target range, which helps you identify trends and make changes that may improve your diabetes and prevent complications, says Kirsten Ward, MS, RCEP, CDE, a diabetes coach with Fit4D.

For everyone with diabetes, blood glucose monitoring primes you for discussions about your glucose data with your health care team. “People can start to take a more proactive role in their own health,” says Ward. “You are in the driver’s seat, and your doctor and certified diabetes educator are in the passenger seat giving you GPS directions.”

4. Can you skip your meds if you don’t see a change in your blood glucose with regular use?B No. i need to continue taking my medications and discuss my expectations and concerns with my doctor.Self-Care Behavior:Taking Medication

“Diabetes is a chronic condition that requires chronic attention,” says Nathan. That includes taking your medication as prescribed. Not taking your meds consistently is one reason you might see little effect on your blood glucose. The result of skipped medication can be dangerous highs in the short term and potential complications long term.

If you’re taking meds but not seeing results, your medications may not be powerful enough to lower glucose significantly, or your body may be producing less insulin than when the drug was prescribed. “This is the major reason patients with type 2 diabetes need higher doses of a medication and additional medications over time,” he says.

Medication is just one factor in how you’re able to manage your diabetes. Food, activity, stress, sleep patterns, and other variables can lead to elevated blood glucose levels, too. “There are many pieces that play into managing diabetes,” says Mitchell. Stay the course and voice your concerns with your doctor at your next visit. He or she may adjust the dose or consider a different medication.

5. you’ve been feeling good lately. can you skip routine doctor visits until you have a problem?A No. i still need to go to my scheduled checkups, as these visits help screen for diabetes-related complications.Self-Care Behavior:Reducing Risks

Routine doctor visits will help you stay on track with your diabetes management in a couple of ways: You’ll get regular A1C checks to monitor your blood glucose, and you’ll receive tests and exams to catch complications early. “The good news about the 21st century is we actually have the tools, and we know how to effectively reduce the risk of long-term complications,” says Nathan. Blood tests can uncover issues such as kidney disease, while eye and foot exams can illuminate early signs of eye disease and loss of nerve function. Once caught, treatments can work to slow or stop the progression of complications.

Be sure to keep up with your routine primary care appointments, diabetes specialist visits, and eye exams to make sure you’re getting the appropriate tests and screenings.

6. If you don’t understand results from your blood glucose checks, is it best to wait until your next scheduled appointment with a health care provider to get advice?C No. I can call my doctor or diabetes educator to talk about my readings. Self-Care Behavior:Problem Solving

Having faith in your health care team is a good thing. They are there to help you manage your diabetes, after all. But diabetes management involves more than twice-yearly doctor visits. “So much is up to the patient to take care of their own diabetes,” says Nathan. That requires an extra layer of problem-solving and the ability to adjust your diabetes management on the fly.

Ideally, you’ll be able to monitor your blood glucose and interpret the data yourself. That will allow you to act faster to improve your levels than if you tried to wait for a doctor’s appointment. But sometimes situations arise where you’re not sure what to do. In that case, it’s best to call your doctor or certified diabetes educator to get a quick answer. “You’d be able to change lifestyle behaviors before [your A1C] gets up to 8.5 or 9 percent and your doctor is adding another pill [or] injection,” says Ward. Diabetes medications can also be adjusted between visits, if necessary.

If you find you constantly have questions, perhaps it’s time for a refresher on how to interpret your readings. Make an appointment with your diabetes educator or attend a diabetes self-management education course in your area.

7. Managing your diabetes on a daily basis has you on an emotional roller coaster. Is there any point in discussing your feelings? C Yes. I have friends, family, caregivers, coworkers, a health care team, and people in the diabetes community who can be my support system. Self-Care Behavior:Healthy Coping

A lot of people feel like they can’t talk about their diabetes or engage in diabetes management in public for fear of what others will think, says Nicole Bereolos, PhD, MPH, CDE, a certified diabetes educator and psychologist in private practice in Dallas. While it’s normal to feel this way, that doesn’t mean it’s the best way to cope. In the long run, it can affect your health. That’s why a support system is key in helping you manage the ups and downs of diabetes.

Begin building your support network before you need it. Make a list of people who are positive and supportive of your diabetes self-care. In addition to family, look to friends, coworkers, or neighbors to deepen the healthy relationships you have. If that isn’t an option, try meeting new people with diabetes. You can join a support group that meets regularly or one that gathers virtually through online blogs or social media. You may also want to consider volunteering. Research suggests that it increases social interaction, helps you build your support system, and has both mental and physical health benefits. Once you’ve learned to cope better with your diabetes, “that will translate to better coping for just about every other stress in your life,” says Bereolos.

ScoreCard

Pencils down. Now, let’s see how you did. Give yourself five points for each correct answer, then add up the total to discover your diabetes IQ.

0-10 PointsNovice KnowledgeYou’ve got a few things to learn about diabetes self-care, but luckily there are lots of resources to help get you up to speed.

15-25 PointsPretty ProficientYou understand how to take care of yourself with diabetes, but there’s always room for improvement.

30-35 PointsExpert EducationYou have a good handle on diabetes self-care.